Sutton and Sykes (1956) studied the characteristics of the tremor superimposed on a voluntary muscular contraction under two conditions; (a) when the subjects were provided with a visual display of the accuracy with which they were maintaining a constant force, and (b) when they carried out the same task with the eyes closed. It was observed that when the subjects' eyes were closed, the tremor amplitude at 8–9 c/s (cycles per second) was sometimes relatively much diminished. In some subjects there was evidence of a smaller reduction in amplitude at other frequencies. Young (1933) had made similar findings using a less satisfactory technique. The findings of these workers have been confirmed and extended in another investigation (Carrie, 1965).

The two studies described here were concerned with the effect of intravenous sodium amytal on autonomic and muscle activity in groups of female patients admitted to the Bethlem Royal Hospital with a primary depressive illness. The first aimed to repeat certain aspects of the work of Shagass et al. (1956) on sleep thresholds in which reactions to sodium amytal were correlated with clinical groupings. The clinical findings of this experiment have already been reported (Martin and Davies, 1962), and its results suggested some methodological problems which prompted a second experiment employing a modified experimental design.

The future of the psychiatric services, in particular of the mental hospital, has been the source of much speculation since the publication of the Hospital Plan for England and Wales (1962). According to the Plan there would, by 1975, be psychiatric accommodation in each Region at the level of 1·;8 beds per 1,000 population, as estimated by Tooth and Brooke (1961).

It is now widely held that many psychiatric patients who would formerly have required institutional care may be maintained in health outside hospital. It is also sometimes suggested that mental illness may be prevented by suitable extramural agencies. For these purposes out-patient clinics, day clinics, domiciliary visiting and social clubs have all been recommended and used in numerous countries. Amongst these measures social clubs for elderly psychiatric patients can be expected to play a useful part, but have so far received little formal description. One of us (Smith, 1963) has reported elsewhere the organization, economics and characteristic atmosphere of such a club. We present here some data on the type of patient who may benefit from such a club and the effect upon his/her record of hospital treatment.

Attempts to correlate diagnosis or prognosis in depression with metabolic or autonomic parameters have been largely unsuccessful. Although electrolyte fluctuations coincide with some cyclical psychoses (Rey, 1957) these may be causal or incidental and their endocrine origin is undefined. Similar difficulties are inherent in studies of autonomic function (Martin, 1960) which have included observations on skin temperature and resistance (G.S.R.), heart rate, pupil reactions and muscle potentials. Much interest has focused on the blood pressure, and the Funkenstein test has emphasized the difficulties of this research. After widespread study and application, its prognostic value, the reliability of its measurements and the basic theoretical assumptions are now largely discredited (Rose, 1962). In the search for reliable objective criteria to evaluate or explain the phenomena of mental illness salivary secretion may prove of considerable value.

It still seems to be current opinion regarding psychiatric in-patients that a bed requirement of 1·8 per 1,000 will cover all needs in the future.

A number of writers have drawn attention to the importance of emotional factors in phantom limb pain (Kolb, 1950, 1952; Simmel, 1956; Russell, 1959; Von Hagen, 1963). Kolb (1950, 1952) reported an association between the discussion of certain emotionally loaded topics and accesses of pain in the phantom. Stengel (1965), in his Maudsley Lecture, discussed the role played in these experiences by the psychological mechanism of identification with others. He briefly referred to the patient whom we have studied.

On first inspection, there may seem to be little difference between a simple experimental post-hypnotic suggestion (p.h.s.) and a simple therapeutic post-hypnotic suggestion. The difference is not so much between the form of the experimental and the form of the therapeutic p.h.s., but between the patterns of behavioural tendencies on which the experimental and the therapeutic post-hypnotic suggestions are respectively superimposed. The experimental p.h.s. is superimposed on the behavioural tendencies dictated by the subject's views of the experiment, and his motives probably often include a wish to “perform well”. The experimental subject will seldom have strong motivation to disobey the hypnotist. In the therapeutic setting the situation is entirely different; the therapeutic p.h.s. is frequently superimposed on strong preexisting conscious or sub-conscious tendencies which run counter to the acceptance of the suggestion.

Desipramine (Pertofran) is a metabolite of imipramine (Tofranil) originally isolated by Herrmann, Schindler and Pulver (1959) and found to be identical with the synthetic compound G.35025. Animal experiments (Gillette et al., 1961) suggest a more rapid action for desipramine, and the majority of clinical trials to date confirm this impression for humans (e.g. Kline et al., 1962; Krakowski, 1963). Some controlled trials, however, (Azima et al., 1962; Hollister et al., 1963) fail to establish that desipramine is either faster acting or more effective than imipramine.

The purpose of this study was to investigate the relationships between the changes in the urinary excretion of the major metabolites of some monoamines and the clinical effects induced in schizophrenic subjects by treatment with reserpine or chlorpromazine.

The term “koro” refers to an unfamiliar state of acute anxiety with partial depersonalization leading to the conviction of penile shrinkage and to fears of dissolution. Among the South Chinese (Cantonese) koro is known as suk-yeong. Van Brero in 1897 first discussed the psychopathology of this syndrome on the basis of cases described in South Celebes. He thought it was a peculiar manifestation of obsessional-compulsive illness. After many years the syndrome again received attention from Van Wulftten Palthe (1934), who concluded that it was an unusual form of anxiety neurosis. Slot in the same year also gave an account of it in the Dutch literature. Van Wulftten Palthe (1936, 1937) further mentioned the existence of corresponding female cases who complained of shrinking of the vulval labia and the breasts. He made a distinction between a real anxiety state and an imaginary organic illness based on folk belief, comparable for example to the popular notion in Southern Europe that urinating against the wind would cause a person to “catch a cold” in the metaphorical sense of getting gonorrhoea.

In a paper in the American Journal of Psychiatry, Chapman (1963) states categorically that no extensive follow-up investigations of neurotic patients exist. So long as we do not know the prognosis of neurotic illness, every evaluation of the results of therapy is impossible. Most psychiatrists feel that they help their patients, but one does not know with certainty.

Wing (1963) has recently reviewed the literature, mainly of the last five years, that has contributed much to our knowledge of the rehabilitation process, especially in long hospitalized schizophrenics. Over the same period there has been an increased discharge rate among this group of patients, and the continuation of this trend appears to be one of the expectations upon which plans for future mental hospital bed requirements have been based (Tooth and Brooke, 1961).

Mebanazine (‘Actomol’) introduced in 1960 for the treatment of depression is a monoamine-oxidase inhibitor hydrazine derivative having the following structural formula:

The aims of this paper are first, to describe some clinical features of patients eventually diagnosed as having a depressive illness who were referred to a general hospital clinic set up to study hypochondriasis, and secondly, to investigate why some patients with depressive disorders develop somatic symptoms while others do not.

At present there exist in the literature numerous references to mental illness in different cultures; these vary from consideration of disorders peculiar to certain cultures, e.g. Koro, Latah, Amok, Wihtigo, etc., well reviewed by Yap (Yap, 51) to the problems of acculturation and mental illness. Examples of the latter include the studies of Tooth and Carothers, the latter suggesting that Westernization and detribalization increased the incidence of psychosis in Africans (Carothers, 2; Tooth, 45). Slotkin (42) pointed to the paranoid schizophrenia phenomena among acculturated Menomini. Hallowell (14, 15) found significant Rorschach differences between acculturated and unacculturated Salteaux.

One of the earliest studies on limb blood flow, using a volume plethysmograph to enclose the hand and forearm, was carried out by Hewlett and Van Zwaluwenburg (1909). Two of their patients were pronounced neurasthenics “with labile vasomotor systems” and these authors noted that, excluding subjects with thyrotoxicosis, “the majority of the remaining fast rates occurred in neurasthenics of the vasomotor type”. In 1938 Grant and Pearson, who developed forearm plethysmography to determine blood flow mainly in the skeletal muscle rather than the skin, noted transient increases in forearm flow with mental arithmetic in some subjects, but did not pursue this observation further. This response was studied in more detail by Abramson and Ferris (1940). Their conclusion that mental arithmetic produced an increase in forearm flow due to vasodilatation in the forearm muscles was confirmed by the work of Brod, Fencl, Hejl, and Jirka (1959), who attributed the change to emotional stress.

Nortriptyline (Allegron, Aventyl) is the demethylated metabolite of amitriptyline. Preliminary trials by Bennett (1962), Oltman et al. (1963) and Leahy et al. (1964) indicated that it might be an effective anti-depressant. Forrest et al. (1964) found that it compared favourably with amitriptyline, a widely used anti-depressant of established efficacy. This investigation also compares nortriptyline with amitriptyline.

The possibility that desipramine might prove to be a rapidly acting antidepressant was first raised by laboratory studies. In 1959 desipramine was isolated as a metabolite of imipramine (Hermann et al., 1959; Hermann and Pulver, 1960), and a series of papers then followed (Brodie et al., 1961; Gillette et al., 1961; Sulser et al., 1962) in which it was shown that reserpine-induced inactivity in the rat can be more rapidly reversed by desipramine than by imipramine. This was referred to (Gillette et al., 1961) as an experimental demonstration of the relative rapidity of the “antidepressant” action of the two drugs. Other experimental reports should however warn against incautious interpretation of laboratory findings. Garattini et al. (1962) showed that desipramine is not responsible for all the actions of imipramine: in mice, leptazol convulsions are inhibited by the latter but not by the former drug. Dingell et al. (1964) were able to show considerable species differences in the rate at which imipramine is converted to desipramine and in the rate at which desipramine is then destroyed. Their paper also emphasizes the paucity of information on the metabolism of imipramine in human subjects.

German (1961, 1963) reported that serum from schizophrenic patients, in contrast to that from normal individuals and non-schizophrenic patients, when applied topically to the rat cerebral cortex, increased the amplitude of potentials evoked in the somato-sensory area by stimulation of the contralateral forepaw. Furthermore, similar changes were found when urine extracts were tested in the same manner (German and Kemali, 1963; Kemali, 1964).